268. Single Center Long-Term Survival of 431 Consecutive Continuous Flow Fully Magnetically Levitated Left Ventricular Assist Device Implants
The Ohio State University Wexner Medical Center
Columbus, OH
United States - Contact Me
Dr. Nahush A. Mokadam is the Division Director of Cardiac Surgery at The Ohio State University Wexner Medical Center, where he holds the Kakos and Williams Endowed Professorship in Cardiac Surgery. His clinical expertise includes all aspects of adult cardiac surgery, including minimally invasive valve repair and replacement, all-arterial revascularization, heart and lung transplantation, mechanical circulatory support and aortic root reconstruction. He is internationally recognized as a leader in total artificial heart implantation. Dr. Mokadam has been an avid participant in novel national and international clinical trials, especially in the field of advanced heart failure and minimally invasive LVAD implantation. He collaborates closely with basic scientists and biomedical engineers to promote ground-breaking translational research, resulting in one of the highest NIH-funded Divisions of Cardiac Surgery in the country. Dr. Mokadam also has extensive experience in surgical education, with a focus on high fidelity surgical simulation. He is the Program Director of the integrated six-year cardiothoracic residency program and is committed to developing the next generation of cardiothoracic surgeons while advancing opportunities for women and minorities to pursue careers in cardiothoracic surgery. Under his leadership, the Division of Cardiac Surgery at The Ohio State University Wexner Medical Center has seen a substantial growth in patient volume, an improvement in quality metrics, a rejuvenation of collaborative culture, and a commitment to diversity and inclusion.
Northwell Health
Brooklyn, NY
United States - Contact Me
Aaron Weiss, MD, PhD, is a Staff Cardiac Surgeon at Cleveland Clinic main campus. Dr. Weiss completed his medical degree, integrated cardiothoracic surgery residency, and PhD in Clinical Research at the Icahn School of Medicine at Mount Sinai in New York City.
Description
Methods: From 10/2015-1/2023, 431 patients underwent CF-FML LVAD implant with 890 patient-years of follow-up available. Survival was estimated out to 5-years post-implant overall and stratified by Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) profile, ischemic (ICM) versus non-ischemic cardiomyopathy (NICM), and bridge to transplant (BTT) versus destination therapy (DT) strategies.
Results: Median age at implant was 61 years (15th,85th: 47.3, 71.7) and 109 (25%) patients were female. Preoperatively, at the time of CF-FML LVAD implant, 90 (21%) patients were supported with intra-aortic balloon pumps, 49 (11%) patients with temporary LVAD and 5 (1.2%) were on extracorporeal membrane oxygenation. Overall survival at 1- and 5-years post-implant was 88% and 58%. Intermacs profile was 1 in 19 (4.4%), 2 in 147 (34%), 3 in 125 (29%), and 4-7 in 145 (33%) patients. For Intermacs profile 1, 6-month survival was 66%. Survival at 1- and 5-years was 89% and 59% in profile 2, 94% and 68% in profile 3, and 84% and 59% in profiles 4-7, respectively. In NICM patients, survival at 1- and 5-years was 91% and 65%, and in ICM patients it was 84% and 53%. Survival did not differ in the early post-implant phase (≤3 weeks) between NICM and ICM patients (P=0.9) but was higher among NICM patients in the late post-implant phase beyond 3 weeks (P=0.006). For BTT patients, 1- and 5-year survival was 89% and 67% whereas DT survival was 87% and 55%, respectively.
Conclusion: This large single center experience demonstrates excellent long-term survival on CF-FML LVAD support. Survival was greatest among profile 3 patients potentially representing the benefit of timely intervention in advanced heart failure prior to deterioration. Survival was also increased among NICM compared to ICM patients and BTT compared to DT patients. Further studies to identify subpopulation-specific risk factors may allow for further improvement of outcomes.
Authors
Aaron Weiss (1), Jean-Luc Maigrot (1), Michael Tong (1), Randall Starling (1), Nicholas Smedira (1), Shinya Unai (1), David Moros (1), Jerry Estep (2), Eugene Blackstone (1), Edward Soltesz (1)
Institutions
(1) Cleveland Clinic, Cleveland, OH, (2) Cleveland Clinic Florida, Weston, FL